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1.
  • Kehoe, Laura, et al. (författare)
  • Make EU trade with Brazil sustainable
  • 2019
  • Ingår i: Science. - : American Association for the Advancement of Science (AAAS). - 0036-8075 .- 1095-9203. ; 364:6438, s. 341-
  • Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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2.
  • Bergström, Göran, 1964, et al. (författare)
  • Prevalence of Subclinical Coronary Artery Atherosclerosis in the General Population
  • 2021
  • Ingår i: Circulation. - Philadelphia : American Heart Association. - 0009-7322 .- 1524-4539. ; 144:12, s. 916-929
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Early detection of coronary atherosclerosis using coronary computed tomography angiography (CCTA), in addition to coronary artery calcification (CAC) scoring, may help inform prevention strategies. We used CCTA to determine the prevalence, severity, and characteristics of coronary atherosclerosis and its association with CAC scores in a general population.Methods: We recruited 30 154 randomly invited individuals age 50 to 64 years to SCAPIS (the Swedish Cardiopulmonary Bioimage Study). The study includes individuals without known coronary heart disease (ie, no previous myocardial infarctions or cardiac procedures) and with high-quality results from CCTA and CAC imaging performed using dedicated dual-source CT scanners. Noncontrast images were scored for CAC. CCTA images were visually read and scored for coronary atherosclerosis per segment (defined as no atherosclerosis, 1% to 49% stenosis, or ≥50% stenosis). External validity of prevalence estimates was evaluated using inverse probability for participation weighting and Swedish register data.Results: In total, 25 182 individuals without known coronary heart disease were included (50.6% women). Any CCTA-detected atherosclerosis was found in 42.1%; any significant stenosis (≥50%) in 5.2%; left main, proximal left anterior descending artery, or 3-vessel disease in 1.9%; and any noncalcified plaques in 8.3% of this population. Onset of atherosclerosis was delayed on average by 10 years in women. Atherosclerosis was more prevalent in older individuals and predominantly found in the proximal left anterior descending artery. Prevalence of CCTA-detected atherosclerosis increased with increasing CAC scores. Among those with a CAC score >400, all had atherosclerosis and 45.7% had significant stenosis. In those with 0 CAC, 5.5% had atherosclerosis and 0.4% had significant stenosis. In participants with 0 CAC and intermediate 10-year risk of atherosclerotic cardiovascular disease according to the pooled cohort equation, 9.2% had CCTA-verified atherosclerosis. Prevalence estimates had excellent external validity and changed marginally when adjusted to the age-matched Swedish background population.Conclusions: Using CCTA in a large, random sample of the general population without established disease, we showed that silent coronary atherosclerosis is common in this population. High CAC scores convey a significant probability of substantial stenosis, and 0 CAC does not exclude atherosclerosis, particularly in those at higher baseline risk.
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3.
  • Bergström, Göran, et al. (författare)
  • Prevalence of Subclinical Coronary Artery Atherosclerosis in the General Population
  • 2021
  • Ingår i: Circulation. - : Wolters Kluwer. - 0009-7322 .- 1524-4539. ; 144:12, s. 916-929
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Early detection of coronary atherosclerosis using coronary computed tomography angiography (CCTA), in addition to coronary artery calcification (CAC) scoring, may help inform prevention strategies. We used CCTA to determine the prevalence, severity, and characteristics of coronary atherosclerosis and its association with CAC scores in a general population.Methods: We recruited 30 154 randomly invited individuals age 50 to 64 years to SCAPIS (the Swedish Cardiopulmonary Bioimage Study). The study includes individuals without known coronary heart disease (ie, no previous myocardial infarctions or cardiac procedures) and with high-quality results from CCTA and CAC imaging performed using dedicated dual-source CT scanners. Noncontrast images were scored for CAC. CCTA images were visually read and scored for coronary atherosclerosis per segment (defined as no atherosclerosis, 1% to 49% stenosis, or ≥50% stenosis). External validity of prevalence estimates was evaluated using inverse probability for participation weighting and Swedish register data.Results: In total, 25 182 individuals without known coronary heart disease were included (50.6% women). Any CCTA-detected atherosclerosis was found in 42.1%; any significant stenosis (≥50%) in 5.2%; left main, proximal left anterior descending artery, or 3-vessel disease in 1.9%; and any noncalcified plaques in 8.3% of this population. Onset of atherosclerosis was delayed on average by 10 years in women. Atherosclerosis was more prevalent in older individuals and predominantly found in the proximal left anterior descending artery. Prevalence of CCTA-detected atherosclerosis increased with increasing CAC scores. Among those with a CAC score >400, all had atherosclerosis and 45.7% had significant stenosis. In those with 0 CAC, 5.5% had atherosclerosis and 0.4% had significant stenosis. In participants with 0 CAC and intermediate 10-year risk of atherosclerotic cardiovascular disease according to the pooled cohort equation, 9.2% had CCTA-verified atherosclerosis. Prevalence estimates had excellent external validity and changed marginally when adjusted to the age-matched Swedish background population.Conclusions: Using CCTA in a large, random sample of the general population without established disease, we showed that silent coronary atherosclerosis is common in this population. High CAC scores convey a significant probability of substantial stenosis, and 0 CAC does not exclude atherosclerosis, particularly in those at higher baseline risk.
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4.
  • Larsson, Alexandra C, 1986, et al. (författare)
  • Figuring Out Life After Covid-19 : a Qualitative Study From Sweden
  • 2023
  • Ingår i: Journal of Rehabilitation Medicine. - 1650-1977 .- 1651-2081. ; 55
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: To obtain a deeper understanding of the daily life experiences of working aged people during the year following hospitalization due to SARS-CoV-2 (COVID-19), with a focus on function-ing in daily life and return to work.DESIGN: An explorative qualitative study using individual interviews.SUBJECTS: A purposive sample was selected of persons who had received inpatient hospital care, had been discharged approximately 1 year previously and were of working age.METHODS: Semi-structured interviews were conducted with 11 participants (9 men, 2 women). The interviews were transcribed and analysed with inductive thematic analysis.RESULTS: Four themes were identified. Navigating health, with or without support from healthcare, was described as challenging when managing consequences of COVID-19. Participants struggled with a lack of energy that interfered with daily life. It was a trial-and-error process trying to use familiar strategies in new ways to manage. The return to work process was facilitated by own strategies and support.CONCLUSION: This study contributes increased knowledge of everyday life experiences of people 1 year following hospitalization due to COVID-19. The lack of energy and a struggle to manage health while navigating the healthcare system emphasize the importance of strengthening personal and organizational health literacy to facilitate the recovery process after severe COVID-19.
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5.
  • Larsson, Alexandra C, 1986, et al. (författare)
  • Physical Function, Cognitive Function, and Daily Activities in Patients Hospitalized Due to COVID-19 : A Descriptive Cross-Sectional Study in Sweden.
  • 2021
  • Ingår i: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1661-7827 .- 1660-4601. ; 18:21
  • Tidskriftsartikel (refereegranskat)abstract
    • An estimated 14-20% of people infected with COVID-19 require medical care. The aim of the present study was to evaluate physical function, cognitive function, and daily activities in patients hospitalized due to COVID-19, and to investigate differences depending on age and admission to the intensive care unit (ICU). This prospective descriptive cross-sectional study included a consecutive sample of 211 patients (mean age 65.1 years, 67.3% men) hospitalized due to COVID-19 in Sweden. Data regarding physical function and daily activities were collected in hospital from July 2020 to February 2021. The average length of hospital stay was 33.8 days, and 48.8% of the patients were admitted to the ICU. Physical function (grip- and lower body strength) was reduced in both groups, and significantly more in the older group, ≥65 years old, compared to the younger. Furthermore, the older group also had significantly less ability to perform activities in daily life, and had significantly reduced cognitive function as compared to the younger age group. In patients treated in the ICU, physical impairments as well as the activity level were significantly more pronounced compared to patients not treated in the ICU. Patients hospitalized due to COVID-19 are physically impaired, have mild cognitive impairments, and have difficulties performing daily activities. The findings in this study indicate the need for out-patient follow-up and rehabilitation for patients hospitalized due to COVID-19, especially in older patients and patients treated in the ICU.
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6.
  • Larsson, Alexandra C, 1986, et al. (författare)
  • Self-Assessed Aspects of Health 3 Months after COVID-19 Hospitalization-A Swedish Cross-Sectional Study
  • 2022
  • Ingår i: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1660-4601 .- 1661-7827. ; 19:13
  • Tidskriftsartikel (refereegranskat)abstract
    • It is not yet fully understood how the patients self-assess their overall health in the early recovery after COVID-19 and if certain patient groups are more prominent in perceived long-time effects of COVID-19. The aim of this study was to describe self-assessed aspects of health in body function, activity and participation 3 months after hospitalization due to COVID-19 and identify difference between groups depending in age, sex and level of hospital care. This cross-sectional study consists of self-assessed aspects of health and recovery in 168 participants (mean age 64 years old, 69% men) previously hospitalized patients due to COVID-19. We have previously published data, from hospital discharge, on this cohort were predominantly the older patients and previous ICU-treated participants were affected. In this study there were differences in between groups. Of the study population 72% perceived fatigue, 64% respiratory difficulties, 37% perceived symptoms of anxiety. Three-months after COVID-19 this cohort was overall still affected. The recovery process is multifaced and the cohort heterogeneous, hence the rehabilitation needs to be highly individualized, and the follow-up of this patient group is of importance regardless of age, sex and previous level of hospital care.
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7.
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8.
  • Törnbom, Karin, 1982, et al. (författare)
  • Understanding concerns after severe COVID-19: A self-imposed lockdown guarded by anxiety?
  • 2023
  • Ingår i: PloS one. - : NLM (Medline). - 1932-6203. ; 18:7
  • Tidskriftsartikel (refereegranskat)abstract
    • Many people are struggling to get back to their lives after severe COVID-19. To facilitate their reintegration into everyday life, we need to understand how the process is experienced. We aimed to gain deeper knowledge about this process by interviewing persons one year after hospitalisation due to COVID-19.The study is based on a qualitative design, with eleven in-depth interviews conducted one year after discharge for COVID-19. Participants were recruited to form a heterogeneous sample with respect to age, gender and socioeconomic background. All interviews were analysed utilising inductive thematic analysis.From the participants' narratives four themes were identified: 'Concerns and worries in everyday life', 'Supportive and concerned relatives', 'A new way of life-sorrows and advantages' and 'Seize the day-a greater awareness of one´s mortality'. Participants described how they tried to create a functioning everyday life. They were generally afraid of getting COVID-19 again and concerned about future life, where their lack of energy played a major role. Narratives were diverse regarding to what extent the struggle to cope was experienced as emotionally challenging or not.Participants described an unpredictable recovery after COVID-19, characterised by ups and downs, which created worries concerning their future. In some cases, the worry of getting COVID-19 again was strong enough to keep participants in their homes, as a self-imposed lockdown guarded by anxiety. However, the narratives also revealed gratitude towards being alive and having coped so well. This led to a more positive outlook on life with a greater focus on intrinsic values, close social relations and the deeper meaning of life.
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9.
  • Abzhandadze, Tamar, 1980, et al. (författare)
  • Impact of pre-pandemic sick leave diagnoses on the length of COVID-19-related sick leave: a nationwide registry-based study
  • 2023
  • Ingår i: Bmc Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 23:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The COVID-19 pandemic has caused difficulties and changes in many aspects of people’s health and lives. Although infection affected work capacity, during the first wave policies for sick leave due to COVID-19 were unclear. The aim of this study was to investigate the impact of sick leave diagnoses in the year before the COVID-19 diagnosis on sick leave duration due to COVID-19 in a nationwide non-hospitalised population. Methods: Data from three Swedish registries were analysed for sick leave commencing between 1 March and 31 August 2020, with a follow-up period of 4months. Sick leave due to COVID-19 was considered the number of days that sickness benefits were used and included at least one registered COVID-19 diagnosis. Sick leave in the year before COVID-19 diagnosis were categorised into five diagnostic groups and one reference group (participants without prior sick leave). Results: The study comprised 8935individuals who received sickness benefits due to COVID-19 in Sweden during the first pandemic wave (mean age 46.7years, 67% females, and 24% had diagnoses for sick leave in the year before COVID-19diagnosis). The duration of sick leave due to COVID-19 was significantly higher in the groups with prior sick leave owing to musculoskeletal system diseases (odds ratio [OR]: 1.08, 95% confidence interval [CI]: 1.01–1.15); respiratory system diseases (OR: 1.22, 95% CI: 1.14–1.31); all other isolated diagnoses (OR: 1.08, 95% CI: 1.03–1.14); and multiple diagnoses (OR: 1.32, 95% CI: 1.21–1.43). Conclusions: The results of this nationwide registry-based study indicate that individuals with premorbid conditions are more prone to longer sick leave durations due to COVID-19. Prediction of sick leave duration during the first wave of the COVID-19 pandemic is complex and several factors played a role. © 2023, The Author(s).
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10.
  • Abzhandadze, Tamar, 1980, et al. (författare)
  • Sick leave oneyear after COVID-19 infection: a nationwide cohort study during the first wave in Sweden.
  • 2024
  • Ingår i: Scientific reports. - 2045-2322. ; 14:1
  • Tidskriftsartikel (refereegranskat)abstract
    • This study aimed to investigate the patterns of sick leave, as well as factors associated with sick leave due to COVID-19 during one year after the COVID-19 diagnosis, and sex-related aspects on sick leave. This nationwide study involved 11,902 individuals who received sickness benefits for COVID-19 during the first wave of the pandemic. Data from three Swedish registries were analyzed for sick leave that commenced between March 1 and August 31, 2020, with a follow-up period of 12months. Sick leave due to COVID-19 was counted as the number of days with sickness benefits and required to include at least one registered COVID-19 diagnosis. The median duration of sick leave was 35days, and 347 (2.9%) individuals continued their sick leave during the entire follow-up period. Furthermore, 1year later, the cumulative incidence of sick leave was slightly higher in males (3.5%) compared to females (2.7%). Older age, being single with no children, diagnosed with the virus, medium income level, history of sick leave, and need for inpatient care were significantly associated with a higher duration of sick leave due to COVID-19, both in the total population and when stratified by sex. These results indicated that three out of 100 (3%) patients were still on sick leave 1year after their COVID-19 diagnosis. Aspects regarding the importance of sick leave duration differed between males and females and comprised sociodemographic characteristics and need for inpatient care. The results indicated the complexity of sick leave due to COVID-19.
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11.
  • Alt Murphy, Margit, 1970, et al. (författare)
  • Kinematic analysis using 3D motion capture of drinking task in people with and without upper-extremity impairments
  • 2018
  • Ingår i: Journal of Visualized Experiments. - : MyJove Corporation. - 1940-087X. ; :133
  • Tidskriftsartikel (refereegranskat)abstract
    • Kinematic analysis is a powerful method for objective assessment of upper extremity movements in a three-dimensional (3D) space. Three-dimensional motion capture with an optoelectronic camera system is considered as golden standard for kinematic movement analysis and is increasingly used as outcome measure to evaluate the movement performance and quality after an injury or disease involving upper extremity movements. This article describes a standardized protocol for kinematic analysis of drinking task applied in individuals with upper extremity impairments after stroke. The drinking task incorporates reaching, grasping and lifting a cup from a table to take a drink, placing the cup back, and moving the hand back to the edge of the table. The sitting position is standardized to the individual's body size and the task is performed in a comfortable self-paced speed and compensatory movements are not constrained. The intention is to keep the task natural and close to a real-life situation to improve the ecological validity of the protocol. A 5-camera motion capture system is used to gather 3D coordinate positions from 9 retroreflective markers positioned on anatomical landmarks of the arm, trunk, and face. A simple single marker placement is used to ensure the feasibility of the protocol in clinical settings. Custom-made Matlab software provides automated and fast analyses of movement data. Temporal kinematics of movement time, velocity, peak velocity, time of peak velocity, and smoothness (number of movement units) along with spatial angular kinematics of shoulder and elbow joint as well as trunk movements are calculated. The drinking task is a valid assessment for individuals with moderate and mild upper extremity impairment. The construct, discriminative and concurrent validity along with responsiveness (sensitivity to change) of the kinematic variables obtained from the drinking task have been established. © 2018 Journal of Visualized Experiments.
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12.
  • Alt Murphy, Margit, 1970, et al. (författare)
  • SALGOT - Stroke Arm Longitudinal study at the University of Gothenburg, prospective cohort study protocol.
  • 2011
  • Ingår i: BMC neurology. - : Springer Science and Business Media LLC. - 1471-2377. ; 11
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Recovery patterns of upper extremity motor function have been described in several longitudinal studies, but most of these studies have had selected samples, short follow up times or insufficient outcomes on motor function. The general understanding is that improvements in upper extremity occur mainly during the first month after the stroke incident and little if any, significant recovery can be gained after 3-6 months. The purpose of this study is to describe the recovery of upper extremity function longitudinally in a non-selected sample initially admitted to a stroke unit with first ever stroke, living in Gothenburg urban area. METHODS/DESIGN: A sample of 120 participants with a first-ever stroke and impaired upper extremity function will be consecutively included from an acute stroke unit and followed longitudinally for one year. Assessments are performed at eight occasions: at day 3 and 10, week 3, 4 and 6, month 3, 6 and 12 after onset of stroke. The primary clinical outcome measures are Action Research Arm Test and Fugl-Meyer Assessment for Upper Extremity. As additional measures, two new computer based objective methods with kinematic analysis of arm movements are used. The ABILHAND questionnaire of manual ability, Stroke Impact Scale, grip strength, spasticity, pain, passive range of motion and cognitive function will be assessed as well. At one year follow up, two patient reported outcomes, Impact on Participation and Autonomy and EuroQol Quality of Life Scale, will be added to cover the status of participation and aspects of health related quality of life. DISCUSSION: This study comprises a non-selected population with first ever stroke and impaired arm function. Measurements are performed both using traditional clinical assessments as well as computer based measurement systems providing objective kinematic data. The ICF classification of functioning, disability and health is used as framework for the selection of assessment measures. The study design with several repeated measurements on motor function will give us more confident information about the recovery patterns after stroke. This knowledge is essential both for optimizing rehabilitation planning as well as providing important information to the patient about the recovery perspectives. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01115348.
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13.
  • Anjemark, Linnea, et al. (författare)
  • Car accidents in drivers with Parkinson's disease or multiple sclerosis: A Swedish nationwide study
  • 2023
  • Ingår i: European Journal of Neurology. - : Wiley. - 1351-5101 .- 1468-1331. ; 30:6, s. 1631-1638
  • Tidskriftsartikel (refereegranskat)abstract
    • Background and purpose: Parkinson's disease (PD) and multiple sclerosis (MS) can impair driving. However, we lack evidence on car accidents associated with these diseases. The aims of this study were to examine what types of car accident were associated with drivers with PD and MS, compared to individuals with ulcerative colitis (UC; the comparison group), and to evaluate the occurrence of car accidents in relation to years since diagnosis.Methods: This retrospective nationwide, registry-based study included drivers involved in car accidents between 2010 and 2019, based on the Swedish Traffic Accident Data Acquisition database. Data on pre-existing diagnoses were retrieved retrospectively from the National Patient Registry. Data analyses included group comparisons, time-to-event analysis, and binary logistic regression.Results: In total, 1491 drivers, including 199 with PD, 385 with MS, and 907 with UC, were registered to have been involved in a car accident. The mean time from diagnosis to the car accident was 5.6 years for PD, 8.0 years for MS, and 9.4 years for UC. Time to car accident since diagnosis differed significantly (p < 0.001) among groups (adjusted for age). Drivers with PD had more than twice the odds of a single-car accident than drivers with MS or UC, but no differences were observed between MS and UC.Conclusions: Drivers with PD were older and experienced the car accident within a shorter timeframe after disease diagnosis. Although several factors may cause a car accident, fitness to drive could be more thoroughly evaluated for patients with PD by physicians, even early after the diagnosis.
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14.
  • Cook, Peta, et al. (författare)
  • Level of physical activity is positively correlated with perceived impact on life 12 months after stroke: A cross-sectional study.
  • 2020
  • Ingår i: Journal of rehabilitation medicine. - : Medical Journals Sweden AB. - 1651-2081 .- 1650-1977. ; 52:5
  • Tidskriftsartikel (refereegranskat)abstract
    • To examine the relationship between, and impact of, level of physical activity and perceived impact on life at 12 months post-stroke.Cross-sectional study.A total of 73 participants with first-time stroke included in the Stroke Arm Longitudinal study at the University of Gothenburg (SALGOT study), Sweden.Perceived impact of stroke was assessed with the Stroke Impact Scale and level of physical activity was assessed with the Saltin-Grimby Physical Activity Scale at 12 months post-stroke. Data were presented with descriptive and logistic regression analyses.The physically active group perceived their strength, emotion, mobility, participation and overall stroke recovery as significantly less problematic compared with the inactive group. Being physically active contributed to higher scores in the Strength domain (odds ratio, OR 7.89) and in the Stroke Recovery domain (OR 18.55). In the Participation domain being physically active (OR 8.01) and independent (OR 0.162) contributed to higher scores.A positive correlation was found between level of physical activity at 12 months post-stroke and levels of strength, participation and stroke recovery.
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15.
  • Edebol Carlman, Hanna M. T., et al. (författare)
  • Probiotic Mixture Containing Lactobacillus helveticus, Bifidobacterium longum and Lactiplantibacillus plantarum Affects Brain Responses to an Arithmetic Stress Task in Healthy Subjects : A Randomised Clinical Trial and Proof-of-Concept Study
  • 2022
  • Ingår i: Nutrients. - : MDPI. - 2072-6643. ; 14:7
  • Tidskriftsartikel (refereegranskat)abstract
    • Probiotics are suggested to impact physiological and psychological stress responses by acting on the gut-brain axis. We investigated if a probiotic product containing Bifidobacterium longum R0175, Lactobacillus helveticus R0052 and Lactiplantibacillus plantarum R1012 affected stress processing in a double-blinded, randomised, placebo-controlled, crossover proof-of-concept study (NCT03615651). Twenty-two healthy subjects (24.2 ± 3.4 years, 6 men/16 women) underwent a probiotic and placebo intervention for 4 weeks each, separated by a 4-week washout period. Subjects were examined by functional magnetic resonance imaging while performing the Montreal Imaging Stress Task (MIST) as well as an autonomic nervous system function assessment during the Stroop task. Reduced activation in regions of the lateral orbital and ventral cingulate gyri was observed after probiotic intervention compared to placebo. Significantly increased functional connectivity was found between the upper limbic region and medioventral area. Interestingly, probiotic intervention seemed to predominantly affect the initial stress response. Salivary cortisol secretion during the task was not altered. Probiotic intervention did not affect cognitive performance and autonomic nervous system function during Stroop. The probiotic intervention was able to subtly alter brain activity and functional connectivity in regions known to regulate emotion and stress responses. These findings support the potential of probiotics as a non-pharmaceutical treatment modality for stress-related disorders.
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17.
  • Ekstrand, Elisabeth, et al. (författare)
  • Longitudinal changes of self-perceived manual ability the first year after stroke : A cohort study
  • 2020
  • Ingår i: BMC Neurology. - : Springer Science and Business Media LLC. - 1471-2377. ; 20:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Recovery patterns of motor function and activity capacity of the upper extremity after stroke have been described, but less is known about longitudinal changes of perceived manual activity performance. The aim of this study was to investigate longitudinal changes of self-perceived manual ability at several timepoints from onset until 12 months post-stroke in a cohort of consecutively recruited individuals with mild, moderate and severe stroke. Methods: The study included 106 participants from a non-selected cohort with first-ever mild, moderate or severe stroke and impaired upper extremity function (Stroke Arm Longitudinal Study at the University of Gothenburg, SALGOT). Self-perceived manual ability was assessed with the ABILHAND Questionnaire at 3 and 10 days, 4 weeks, 3, 6 and 12 months after stroke. Longitudinal change was assessed by linear mixed models (fixed and random effects) and adjusted models were built by adding effects of cofactors age, gender, stroke severity, living condition and affected hand. Results: Self-perceived manual ability increased over time the first year after stroke for the total group and the subgroups. The final adjusted model for the total group included fix-effects of time (expected mean change 0.24 logits per month) adjusted by age (-0.06 per year) and stroke severity (-0.19 per NIHSS-score). In addition to significant effect of time, the adjusted models for moderate stroke subgroup included fixed effect of age, and for mild and severe subgroups there was an interaction effect between time and age. Further analyses between time-points showed that no significant change of self-perceived manual ability was detected beyond 3 months post-stroke. Conclusions: Self-perceived manual ability increased over time the first year after stroke, and this change was to some degree modulated by age and stroke severity at onset. Most of the improvements occurred early, predominantly within the first three months after stroke.
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18.
  • Ekstrand, Elisabeth, et al. (författare)
  • Which clinical and sociodemographic determinants are associated with self-perceived manual ability at one year after stroke?
  • 2020
  • Ingår i: Disability and Rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 42:16, s. 2279-2286
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: To evaluate the impact of multiple potential sociodemographic and clinical stroke-related determinants on self-perceived manual ability in an unselected sample of individuals 12 months after first-ever stroke. Methods: A cross-sectional sample of 68 participants (mean age 66) with UE impairments were followed up at 12 months post stroke. Stroke severity at onset was moderate for the majority. Manual ability was assessed by the patient-reported outcome measure ABILHAND Questionnaire. Determinants included in the multivariate regression analysis were age, gender, living situation, vocational situation, affected hand, stroke severity at onset and UE disability (motor function, sensory function, joint motion, pain, grip strength, spasticity and activity capacity) at 12 months post stroke. Results: The strongest associated determinants with self-perceived manual ability were UE motor function and UE activity capacity at 12 months post-stroke. UE motor function together with age and grip strength explained 65% of the variance in one final multivariate model. UE activity capacity and grip strength explained 62% of the variance in a second final model. Conclusion: In order to understand self-perceived difficulties in manual ability in daily activities in persons with stroke, assessments of UE motor function and activity capacity are recommended. Implications for rehabilitation The ultimate goal of the upper extremity rehabilitation after stroke is to regain ability to use the UE in daily activities that are important to the individual in his or her own environment. This requires a good understanding of factors that are associated with self-perceived manual ability in order to tailor effective rehabilitation interventions. Upper extremity motor function and activity capacity are the strongest determinants associated with self-perceived manual ability one year after stroke. These factors are recommended to be included in the assessment battery in stroke to fully understand the disability in daily life.
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19.
  • Engwall, Marie, 1964, et al. (författare)
  • Recovering from COVID-19 - A Process Characterised by Uncertainty: A Qualitative study.
  • 2022
  • Ingår i: Journal of rehabilitation medicine. - : Medical Journals Sweden AB. - 1651-2081 .- 1650-1977. ; 54
  • Tidskriftsartikel (refereegranskat)abstract
    • To obtain a deeper understanding of the lived experiences of patients with COVID-19, the recovery process and consequences for everyday life 6 months after hospital discharge.An explorative qualitative study using individual interviews.A purposive sampling was applied to recruit persons who had received inpatient hospital care, were discharged approximately 6 months previously, were of working age and had persistent self-reported symptoms at a 3-month follow-up appointment.Semi-structured interviews were conducted with 15 participants (10 men, 5 women), which were then transcribed and analysed with inductive thematic analysis.Three themes were identified: "Status of recovery - two steps forward, one step back", "Remaining symptoms caused limitations in everyday life" and "Strategies for recovery". Participants indicated the recovery process through 6 months after discharge was a challenging road, often involving setbacks. A wide range of persistent, fluctuating, or new symptoms negatively impacted many areas of daily life, with fatigue and lack of energy being especially prominent. Participants used a variety of strategies to cope and recover.This study increases our knowledge of the lived experiences of COVID-19 based individual experiences. Unexpected symptoms in the recovery process were described and not always possible to forecast.
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20.
  • Fagevik Olsén, Monika, 1964, et al. (författare)
  • Variations in respiratory and functional symptoms at four months after hospitalisation due to COVID-19: a cross-sectional study
  • 2024
  • Ingår i: BMC PULMONARY MEDICINE. - 1471-2466. ; 24:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Background Much remains unknown about complex respiratory symptoms after COVID-19. Here we aimed to describe and analyse patients' various respiratory symptoms 4 months after discharge from hospitalisation for COVID-19, focusing on sex, previous pulmonary disease, and prolonged mechanical ventilation. Methods This cross-sectional study involved five hospitals and included 52 patients with self-assessed respiratory dysfunction at 4 months after discharge from hospitalisation for severe COVID-19. Their average age was 63 years, 38% were women, 15 had a previous diagnosed pulmonary disease, and 29 were current or previous smokers. Additionally, 31 had required intensive care-among whom 21 were intubated and 11 needed mechanical ventilation for >= 20 days. Respiratory function was tested concerning lung volumes, expiratory flow, muscle strength, physical capacity (including concurrent oxygen saturation), thoracic expansion, and respiratory movements. Results Among 52 patients, 47 (90%) had one or several objectively measured respiratory function abnormalities. Decreased thoracic expansion was observed in 32 patients (62%), abnormal respiratory movements in 30 (58%), decreased vital capacity in 21 (40%), low physical function in 13 (26%), and desaturation during the test in 9 (17%). Respiratory inspiratory muscle strength was more commonly diminished than expiratory strength (27% vs. 8%). We did not observe differences between men and women, or between patients with versus without diagnosed pulmonary disease, except that those with pulmonary disease had significantly lower physical capacity assessed with 6MWD (70% vs. 88% predicted, p = 0.013). Compared to those who did not, patients who required >= 20 days of mechanical ventilation performed similarly on most tests, except that all thoracic breathing movements were significantly smaller (p < 0.05). The numbers and combinations of abnormal findings varied widely, without clear patterns. Conclusion Patients with remaining respiratory symptoms 4 months after discharge from hospitalization due to COVID-19 may suffer from various abnormal breathing functions, and dysfunctional breathing that is not detected using traditional measurements. These patients may benefit from multidimensional measuring of breathing movement, thoracic expansion, and respiratory muscle strength, along with traditional measurements, to assess their symptoms and enable prescription of optimal treatment interventions and rehabilitation.
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21.
  • Ghaziani, Emma, et al. (författare)
  • Easily Conducted Tests During the First Week Post-stroke Can Aid the Prediction of Arm Functioning at 6 Months.
  • 2020
  • Ingår i: Frontiers in neurology. - : Frontiers Media SA. - 1664-2295. ; 10
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Prognostic models can estimate the recovery of arm functioning after stroke, guide the selection of individual training strategies, and inform patient selection in clinical trials. Several models for early prediction of arm recovery have been proposed, but their implementation has been hindered by insufficient external validation, limited evidence of their impact on patient outcomes, and reliance on predictors that are not feasible in regular clinical practice. Objectives: To determine the predictive value of new and previously reported tests that can be easily conducted in regular clinical settings for early prognosis of two levels of favorable arm recovery at 6 months post-stroke. Methods: We performed a secondary analysis of merged data (n = 223) from two Scandinavian prospective longitudinal cohorts. The candidate predictors were seven individual tests of motor function and the sensory function measured by the Fugl-Meyer Assessment of Upper Extremity within 7 days post-stroke, and the whole motor section of this assessment. For each candidate predictor, we calculated the adjusted odds ratio (OR) of two levels of residual motor impairment in the affected arm at 6 months post-stroke: moderate-to-mild (≥32 points on the motor section of the Fugl-Meyer Assessment of Upper Extremity, FMA-UE) and mild (FMA-UE ≥ 58 points). Results: Patients with partial shoulder abduction (OR 14.6), elbow extension (OR 15.9), and finger extension (OR 9.5) were more likely to reach FMA-UE ≥ 32. Patients with full function on all individual motor tests (OR 5.5-35.3) or partial elbow extension, pronation/supination, wrist dorsiflexion and grasping ability (OR 2.1-18.3) were more likely to achieve FMA-UE ≥ 58 compared with those with absent function. Intact sensory function (OR 2.0-2.2) and moderate motor impairment on the FMA-UE (OR 7.5) were also associated with favorable outcome. Conclusions: Easily conducted motor tests can be useful for early prediction of arm recovery. The added value of this study is the prediction of two levels of a favorable functional outcome from simple motor tests. This knowledge can be used in the development of prognostic models feasible in regular clinical settings, inform patient selection and stratification in future trials, and guide clinicians in the selection of individualized training strategies for improving arm functioning after stroke. Clinical Trial Registration: ClinicalTrials.gov: NCT02250365, NCT01115348.
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22.
  • Kristersson, Therese, et al. (författare)
  • Evaluation of a short assessment for upper extremity activity capacity early after stroke.
  • 2019
  • Ingår i: Journal of rehabilitation medicine. - : Medical Journals Sweden AB. - 1651-2081 .- 1650-1977. ; 51:4, s. 257-263
  • Tidskriftsartikel (refereegranskat)abstract
    • To explore the concurrent validity, responsiveness, and floor- and ceiling-effects of the 2 items of Action Research Arm Test (ARAT-2) in comparison with the original ARAT and the Fugl-Meyer Assessment for Upper Extremity (FMA-UE) during the first 4 weeks post-stroke.A prospective longitudinal cohort study.A non-selected cohort of 117 adults with first-ever stroke and impaired upper extremity function.The activity capacity and motor function was assessed with ARAT and FMA-UE at 3 days, 10 days and 4 weeks post-stroke.Correlation between ARAT-2 and the other assessment scales was high (r=0.920.97) and ARAT-2 showed statistically significant changes between all time-points (effect size, r=0.310.48). The effect sizes for the change in ARAT and FMA-UE varied from 0.44 to 0.53. ARAT-2, similarly to ARAT, showed a floor effect at all time-points. The ceiling effect was reached earlier using ARAT-2 than with ARAT and FMA-UE.ARAT-2 appears to be valid and a responsive short assessment for upper extremity activity capacity, and suitable for use in the acute stage after stroke. However, when the highest score has been reached, the assessment needs to be complemented with other instruments.
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23.
  • Mühr, Oscar, 1989, et al. (författare)
  • Long-term outcome after reperfusion-treated stroke.
  • 2017
  • Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977. ; 49:4, s. 316-321
  • Tidskriftsartikel (refereegranskat)abstract
    • To explore motor function, health-related quality of life and impact on activities of daily living 5 and 6 years after reperfusion treatment in patients with stroke.A total of 75 patients with first-time stroke received either thrombectomy or thrombolytic treatment at the Sahlgrenska University Hospital in Gothenburg during an 18-month period in 2009-2010. Follow-up involved questionnaires and clinical examinations, 5 and 6 years post-stroke. The results were compared with an individually matched reference group.At follow-up 54 persons with reperfusion-treated stroke were alive, of whom 31 (57%) answered the questionnaires and 16 agreed to a clinical examination. The Stroke Impact Scale showed impact in several areas, with the emotion domain being the most affected. The reperfusion-treated group reported significantly better strength and hand function compared with the reference group. Of those clinically examined, 44% were dependent in activities of daily living and 38% had cognitive impairment.Long-term outcome after reperfusion treatment is relatively good, with treated individuals having better strength and hand function compared with a reference group. However, emotional and cognitive problems persist and need to be addressed.
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24.
  • Nylén, Malin, et al. (författare)
  • A register-based study comparing planned rehabilitation following acute stroke in 2011 and 2017
  • 2021
  • Ingår i: Scientific Reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 11:1
  • Tidskriftsartikel (refereegranskat)abstract
    • This cross-sectional, register-based study aimed to explore patterns of planned rehabilitation at discharge from stroke units in Sweden in 2011 and 2017 and identify explanatory variables for planned rehabilitation. Multivariable binary logistic regression was used to identify variables that could explain planned rehabilitation. There were 19,158 patients in 2011 and 16,508 patients in 2017 with stroke, included in the study. In 2011, 57% of patients were planned for some form of rehabilitation at discharge from stroke unit, which increased to 72% in 2017 (p < 0.001). Patients with impaired consciousness at admission had increased odds for planned rehabilitation (hemorrhage 2011 OR 1.43, 95% CI 1.13-1.81, 2017 OR 1.66, 95% CI 1.20-2.32), (IS 2011 OR 1.21, 95% CI 1.08-1.34, 2017 OR 1.49, 95% CI 1.28-1.75). Admission to a community hospital (hemorrhage 2011 OR 0.56, 95% CI 0.43-0.74, 2017 OR 0.39, 95% CI 0.27-0.56) (IS 2011 OR 0.63, 95% CI 0.58-0.69, 2017 OR 0.54, 95% CI 0.49-0.61) or to a specialized non-university hospital (hemorrhage 2017 OR 0.66, 95% CI 0.46-0.94), (IS 2011 OR 0.90, 95% CI 0.82-0.98, 2017 OR 0.76, 95% CI 0.68-0.84) was associated with decreased odds of receiving planned rehabilitation compared to admission to a university hospital. As a conclusion severe stroke was associated with increased odds for planned rehabilitation and patients discharged from non-university hospitals had consistently decreased odds for planned rehabilitation.
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25.
  • Nylén, Malin, et al. (författare)
  • Prediction of long-term functional outcome following different rehabilitation pathways after stroke unit discharge.
  • 2024
  • Ingår i: Journal of Rehabilitation Medicine. - 1650-1977. ; 56
  • Tidskriftsartikel (refereegranskat)abstract
    • To investigate whether referral for different types of rehabilitation on discharge from Swedish stroke units can predict functional outcomes at 1 and 5 years after a stroke.A longitudinal and registry-based study.A total of 5,118 participants with index stroke in 2011 were followed-up at 1 and 5 years after the stroke.Ordinal logistic regression models were developed to predict the category of functional outcome: independent, dependent, or dead. The primary predictors were planned rehabilitation in a home setting, inpatient rehabilitation, and outpatient rehabilitation, with no planned rehabilitation as the reference category.Planned outpatient rehabilitation predicted independence (compared with death) at 1 year. Planned rehabilitation in the home setting predicted independence (compared with death) at 1 and 5years. Compared with other planned pathways, participants planned for inpatient rehabilitation had more severe conditions, and planned inpatient rehabilitation did not predict independence.Planning for outpatient or home-based rehabilitation appeared to lead more effectively to participants achieving independence over the course of 1-5 years. This may have been due to the less severe nature of these participants' conditions, compared with those requiring inpatient rehabilitation.
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26.
  • Olsson, Ola A., et al. (författare)
  • Early prediction of physical activity level 1 year after stroke: A longitudinal cohort study
  • 2017
  • Ingår i: Bmj Open. - : BMJ. - 2044-6055. ; 7:8
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective To investigate which variables present prior and early after stroke may have an impact on the level of physical activity (PA) 1 year poststroke. Design Prospective longitudinal cohort and logistic regression analysis. Setting Stroke Unit at Sahlgrenska University Hospital, Gothenburg, Sweden. Participants 117 individuals as part of the Stroke Arm Longitudinal Study (SALGOT) admitted to the stroke unit during a period of 18 months were consecutively recruited. The inclusion criteria were: First-time stroke, impaired upper extremity function, admitted to the stroke unit within 3 days since onset, local residency and ≥18 years old. The exclusion criteria were: Upper extremity condition or severe multi-impairment prior to stroke, short life expectancy and non-Swedish speaking. 77 participants followed up at 1 year poststroke were included in the analysis. Primary outcome PA level 1 year after stroke was assessed using a 6-level Saltin-Grimby Scale, which was first dichotomised into mostly inactive or mostly active and second into low or moderate/high level of PA. Results Being mostly inactive 1 year after stroke could be predicted by age at stroke onset (OR 1.07, 95% CI 1.00 to 1.13, p=0.041), functional dependency at discharge (OR 7.01, 95% CI 1.73 to 28.43, p=0.006) and prestroke PA (OR 7.46, 95% CI 1.51 to 36.82, p=0.014). Having a low level of PA 1 year after stroke could be predicted by age at stroke onset (OR 1.13, 95% CI 1.06 to 1.21, p<0.001) and functional dependency at discharge (OR 3.62, 95% CI 1.09 to 12.04, p=0.036). Conclusions Previous low level of PA, older age and functional dependency all provided value in predicting low PA 1 year after stroke. These results indicate that age and simple clinical evaluations early after stroke may be useful to help clinicians identify persons at risk of being insufficiently active after stroke. Further research is needed to clarify if these findings may apply to the large population of stroke survivors. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017.
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27.
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28.
  • Opheim, Arve, 1962, et al. (författare)
  • Is upper-limb sensorimotor function or spasticity the best predictor for spasticity one year poststroke?
  • 2015
  • Ingår i: World Conference in Physical Therapy, Singapore; 05/2015.
  • Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
    • ABSTRACT: Background: Clinical assessments of body functions are an important part of physiotherapy practice poststroke. These assessments are used to plan treatments, and may be used to indicate future function. Upper limb spasticity has been found to be associated with poorer motor function and muscle strength, pain and higher dependence in daily life. Therefore, the identification of patients at risk of developing spasticity may be important. Whether sensorimotor function or spasticity during the first month is the better predictor for spasticity after 1 year is unknown. Purpose: The aim was to investigate whether sensorimotor function or spasticity assessed 4 weeks poststroke was the better predictor for spasticity after 1year. Methods: One hundred and seventeen patients in Gothenburg, Sweden, with first ever stroke and impaired upper-limb function on day 3 was included in this study. The clinical assessments were made 4 weeks and 1 year poststroke. Sensorimotor function was assessed with Fugl-Meyer Upper Extremity scale (FMA-UE), and higher score indicate better function (0-66). Spasticity in elbow flexors and extensors, wrist flexors and extensors, was assessed with the modified Ashworth Scale (MAS), with higher score indicating more spasticity (0-5). The MAS score was dichotomized into: 0=no spasticity and ≥1=spasticity present, and spasticity in any of these muscle groups was regarded as spasticity present. Univariate and multivariate logistic regression analysis was used to analyze the predictors, and odds ratio and 95% were calculated. Results: In univariate analysis, both FMA-UE and MAS were significantly associated with spasticity at one year poststroke. I the multivariate analysis, only FMA-UE (OR 0.91, 95%CI: 0.88-0.95) and age (OR 0.94, 95% CI: 0.89-0.99), was significant predictors for spasticity at 1 year post stroke. Conclusion(s): When both MAS and FMA-UE was analyzed together and controlled for in a multivariate regression analysis, only FMA-UE was significantly associated with spasticity after 1 year. Better sensorimotor function was associated with reduced OR for spasticity. Also, higher age had reduced OR for spasticity. This may imply that upper limb spasticity at 4 weeks poststroke may still be an “unstable” impairment, and not yet manifest. Therefore, sensorimotor function seems to be a better predictor than spasticity 4 weeks after for spasticity one year poststroke. Implications: Poorer sensorimotor function was associated with long-term spasticity and therefore important to assess in the first month poststroke. Assessment of spasticity within the first month to predict long-term spasticity poststroke may be limited. Keywords: Stroke, spasticity, sensorimotor function, clinical assessment scales.
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29.
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30.
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31.
  • Opheim, Arve, 1962, et al. (författare)
  • What comes first, spasticity, reduced range of motion or pain in patients after stroke?
  • 2013
  • Ingår i: Journal of Rehabilitation Medicine. Presented at the 3rd Baltic and North Sea Conference on Physical & Rehabilitation Medicine, the 118th Congress of the German Society for Physical Medicine & Rehabilitation, and the annual Congress for the Austrian Society for Physical Medicine & Rehabilitation. September 2013, Hannover, Germany. - : Medical Journals Sweden AB. - 1650-1977. ; 45
  • Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
    • Introduction Pain, reduced range of motion (ROM) and reduced motor function has been found to be associated with spasticity in persons with stroke, but the developments of these impairments over time are less known. The aim of the study was to describe the development of spasticity, pain, ROM, sensibility and sensory motor function in persons with first stroke during the first year after stroke. Method 117 patients with first ever stroke was recruited for the study. No selections apart from reduced arm function on day 3 were made. The patients were assessed six times during the first year, at day 3, 10, week 4, month 3, 6 and 12. Upper limb spasticity was assessed with the modified Ashworth scale (MAS), and a MAS score ≥ 1 was regarded as presence of spasticity. Sensory motor function was assessed with the Fugl-Meyer Upper-Extremity scale (FM-UE). The presence of pain, reduced sensibility and range of motion (ROM) was regarded if lower than maximum scores on the non-motor domains of the FM-UE. Results The proportion of persons with spasticity increased from 0.25 at day 3 to 0.44 at week 4 and was stable up to 12 months. Sensory motor function improved from 28 (SD 25) at day 3 to 47 (SD 23) at 3 months and was stable up to 12 months. The proportion of persons with reduced ROM was 0.45 at day 3, was stable up to 3 months and increased at 6 and 12 months, 0.55 and 0.61, respectively. The proportion of patients with reduced sensibility decreased from 0.55 at day 3 to 0.36 at 12 months. Discussion Pain, spasticity and sensory motor function seemed to develop in about parallel the first 3 months. The proportion of persons with pain continued to increase during the first year. The proportion of patients with reduced ROM was unchanged during the first three months, but increased at 6 and 12 months. Based on this, reduced upper limb ROM seems secondary to pain and spasticity.
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32.
  • Palstam, Annie, 1981, et al. (författare)
  • Recurrent sick leave after COVID-19: investigating the first wave of the pandemic in a comprehensive Swedish registry-based study
  • 2021
  • Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 21:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Background Sick-leave due to COVID-19 vary in length and might lead to re-current episodes. The aim was to investigate recurrent sick leave due to COVID-19 during the first wave. Methods This is a registry-based cohort study. The study comprises all people with sickness benefit due to COVID-19 in Sweden in March 1-August 31, 2020. Data from the Swedish Social Insurance Agency, the Swedish National Board of Health and Welfare, and Statistics Sweden were merged. Results Within the follow-up period of 4 months, 11,955 people were subject to sickness benefit due to COVID-19, whereof 242 people (2.0%) took recurrent sick leave due to COVID-19, and of those 136 (56.2%) remained on sick leave at the end of follow-up. People with recurrent sick leave were older, more often women, and more likely to have been on sick leave prior to the COVID-19 pandemic. Conclusion A group of people presented with recurrent sick leave due to COVID-19. For half of them, the second sick leave lasted throughout the follow-up. People with recurrent sick leave differ in several aspects from those with shorter sick leave. To capture long-term sick-leave patterns due to COVID-19, a longer period of follow-up is needed.
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33.
  • Palstam, Annie, 1981, et al. (författare)
  • Work-related predictors for return to work after stroke.
  • 2019
  • Ingår i: Acta neurologica Scandinavica. - : Hindawi Limited. - 1600-0404 .- 0001-6314. ; 139:4, s. 382-388
  • Tidskriftsartikel (refereegranskat)abstract
    • Disability due to stroke imposes a large burden on individuals, and on society, in terms of impaired work ability and sick leave. The reported return to work (RTW) rate after stroke varies globally and is influenced by a range of different aspects. The aim of this study was to investigate the influence of work-related factors on time to RTW after stroke, and possible differences between the sexes.Data from 204 persons with first-time stroke in the years 2009-2010 in Gothenburg, Sweden, who were of working age and had worked prior to their stroke, were analysed. Disease-related characteristics were retrieved from medical records, and work-related- and socio-economic data were collected up to 6years post-stroke from Statistics Sweden and the Swedish Social Insurance Agency. Cox regression was used to analyse predictors for time to RTW.We identified qualified occupation and large organizational size as work-related predictors for shorter time to RTW after stroke. Being male predicted a faster and higher frequency of RTW. Qualified occupation predicted shorter time to RTW in men but not in women. For women, the only predictor for RTW was physical dependency at discharge.Type of work and organizational size are work-related factors of importance for RTW after stroke. Work-related factors were important for RTW in men, but not in women. Reasons for differences between men and women in work-related factors that influence RTW need to be further investigated to better understand how to support women in the RTW process.
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34.
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35.
  • Persson, Hanna C, 1979, et al. (författare)
  • A cohort study investigating a simple, early assessment to predict upper extremity function after stroke - a part of the SALGOT study
  • 2015
  • Ingår i: Bmc Neurology. - : Springer Science and Business Media LLC. - 1471-2377. ; 15
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: For early prediction of upper extremity function, there is a need for short clinical measurements suitable for acute settings. Previous studies demonstrate correct prediction of function, but have ether included a complex assessment procedure or have an outcome that does not automatically correspond to motor function required to be useful in daily activity. The purpose of this study was to investigate whether a sub-set of items from the Action Research Arm Test (ARAT) at 3 days and 1 month post-stroke could predict the level of upper extremity motor function required for a drinking task at three later stages during the first year post-stroke. Methods: The level of motor function required for a drinking task was identified with the Fugl-Meyer Assessment for Upper Extremity (FMA-UE). A structured process was used to select ARAT items not requiring special equipment and to find a cut-off level of the items' sum score. The early prognostic values of the selected items, aimed to determine the level of motor function required for a drinking task at 10 days and 1 and 12 months, were investigated in a cohort of 112 patients. The patients had a first time stroke and impaired upper extremity function at day 3 after stroke onset, were >= 18 years and received care in a stroke unit. Results: Two items, "Pour water from glass to glass" and "Place hand on top of head", called ARAT-2, met the requirements to predict upper extremity motor function. ARAT-2 is a sum score (0-6) with a cut-off at 2 points, where >2 is considered an improvement. At the different time points, the sensitivity varied between 98 % and 100 %, specificity between 73 % and 94 %. Correctly classified patients varied between 81 % and 96 %. Conclusions: Using ARAT-2, 3 days post-stroke could predict the level of motor function (assessed with FMA-UE) required for a drinking task during the first year after a stroke. ARAT-2 demonstrates high predictive values, is easily performed and has the potential to be clinically feasible.
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36.
  • Persson, Hanna C, 1979, et al. (författare)
  • A cross sectional study of upper extremity strength ten days after a stroke; relationship between patient-reported and objective measures
  • 2015
  • Ingår i: Bmc Neurology. - : Springer Science and Business Media LLC. - 1471-2377. ; 15
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Reduced upper extremity function early after a stroke is common, and a combination of strength capacity and patient-reported measures contribute to setting realistic goals. The validity of the patient's perception of upper extremity strength in relation to objective strength assessments early after a stroke needs to be clarified. The objective was to investigate the relationship between perceived upper extremity strength and measured hand strength at ten days post-stroke. Methods: This study of 99 patients with reduced upper extremity function at 3 days post stroke, were consecutively included from a stroke unit to the Stroke Arm Longitudinal Study at the University of Gothenburg, (the SALGOT-study). The correlations between two questions from the Stroke Impact Scale (SIS 1a and 1b), and a dynamometer measure of hand strength values (percentage of normative values) were investigated. In order to explain differences between the two types of measurements, the accordance between perceived strength in a dichotomized SIS and objective measures was explored. In SIS 1a and 1b, 1-3 points correspond to reduced strength (<80 % or normative strength values). In SIS 1a and 1b, 4-5 points correspond to normal strength (>= 80 % of normative strength values). Results: The correlation between the measured strength values and perceived arm strength was rho 0.82 (p = < 0.001) and with perceived grip strength rho 0.87 (p = < 0.001). Using the dichotomized SIS and the 80 % cut-off correctly classified arm strength in 81 % and grip strength in 84 % of the patients, with a sensitivity of 0.86-0.87, a specificity of 0.62-0.77, positive predicted values of 0.87-0.91 and negative predicated values of 0.64-0.67. Discussion: The discrepancy between assessed strength capacity and self-perceived strength highlights the importanceof including self-perceived assessments early after stroke, in order to increase knowledge of a patient'sawareness of functioning or lack thereof. Conclusions: Ten days after stroke in patients without severe cognitive disabilities, this study suggests that despite high correlations between measures, an objective assessment of arm and hand strength does not always reflect the patient's perspective. A combination of self-reported and objective strength assessment is requested to enhance in setting of realistic goals early after stroke.
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37.
  • Persson, Hanna C, 1979, et al. (författare)
  • Armfunktion inom 72 timmar efter förstagångsstroke i en oselekterad patientgrupp, samt vårdförlopp och utfall vid utskrivning. En del av SALGOT-studien.
  • 2013
  • Ingår i: Sjukgymnastdagarna 2013. Göteborg 2-4 oktober 2013..
  • Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
    • Bakgrund och syfte Nedsatt funktion i övre extremitet efter en stroke har rapporterats förekomma akut hos 70-80%. Akutvården förändras med fler som vårdas på strokeenhet så väl som behandlas med trombolys. Syftet var att i en oselekterad patientgrupp med förstagångsstroke, undersöka vårdförlopp och utskrivningsstatus samt förekomst av nedsatt arm och handfunktion inom 72 timmar efter insjuknande. Ett andra syfte var att undersöka faktorer som associeras med nedsatt övre extremitet och dess påverkan på utfallet. Metoder Inklusionskriterier var: förstagångsstroke, över 18 år, boende i geografiskt upptagningsområde, på strokeenheten inom 72 timmar efter insjuknade, ingen tidigare nedsatt funktion i övre extremitet. Via journalgranskning samlades bakgrundsdata, arm och handfunktion, utfall av stroke och sjukhusvård. Infarkter klassificerades enligt Bamford och med TOAST. Resultat och diskussion Av screenade 969 patienter med förstagångsstroke uppfyllde 642 inklusionskriterierna. Vid ankomst bedömdes patientens funktion med NIHSS, medelvärde 6.0. Förekomst av nedsatt arm och handfunktion inom 72 timmar efter insjuknade var 48%, vilket också samvarierade med ålder (p<0.004), vårdtid (p<0.001) och dödlighet inom akutvården (p<0.001). Det var 89% av patienterna som lades in direkt på strokeenheten och 77% kom till sjukhuset på insjuknadedagen. Medelvårdtiden på strokenheten var 10 dagar och 57% utskrevs till hemmet. Dödligheten inom 72 timmar var 5%. Konklusion Nedsatt arm och handfunktion inom 72 timmar efter insjuknande i förstagångsstroke förekommer hos 48% av patienterna. Nedsatt övre extremitet associerar med högre ålder, längre vårdtider inom strokeenheten och högre dödlighet i akutvården.
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38.
  • Persson, Hanna C, 1979, et al. (författare)
  • Consequences and coping strategies six years after a subarachnoid hemorrhage - A qualitative study
  • 2017
  • Ingår i: Plos One. - : Public Library of Science (PLoS). - 1932-6203. ; 12:8
  • Tidskriftsartikel (refereegranskat)abstract
    • Background After a subarachnoid haemorrhage (SAH), continuing impairment is common and may impact the person's life. There is a lack of knowledge regarding long-term consequences experienced. To explore experiences of the care and rehabilitation as well as the consequences and strategies used to cope with everyday life six years post SAH. An explorative interview study with a qualitative design. Individual interviews, with open ended questions, using an interview guide were performed with sixteen participants (mean age 63, 8 men, 8 women) six years post SAH. Data was analyzed according to a descriptive thematic analysis, and themes were discovered inductively. Two major themes from the analysis, both including four sub-themes, were identified; these themes were consequences of the SAH and coping strategies. Participants were grateful to have survived the SAH and most were satisfied with their acute medical care. If discharged directly from the neurosurgical unit participants can feel abandoned. In contrast, participants who were referred to a rehabilitation clinic felt supported and informed. Cognitive problems, such as impaired memory and mental fatigue, were reported as still present six years post SAH. Coping strategies were; receiving support from family, society, employers, or technical equipment. At work, talking to colleagues and to taking breaks were common. Participants described hiding their symptoms from employers and friends, as well as trying to continue doing tasks in the same manner as prior to the SAH. If this was not possible, some refrained from doing these tasks. They went through a mourning process, fear, and worries. Participants reported several long-term consequences which impacted on their daily lives post SAH, and different coping strategies were used to cope with these problems. Participants reported lack of awareness regarding the consequences of SAH and stressed the importance of structured multidisciplinary follow-ups, which mostly is missing.
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39.
  • Persson, Hanna C, 1979, et al. (författare)
  • Differences in recovery of upper extremity functioning after ischemic and hemorrhagic stroke – part of the SALGOT study.
  • 2016
  • Ingår i: 2nd European Stroke Organisation Conference, 10-12 May, 2016, Barcelona, Spain.
  • Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
    • Background It is unclear if and how the type of stroke influences the recovery of motor function after stroke. The purpose was to assess if there are differences in extent of change in upper extremity motor function and activity capacity, in persons with ischemic versus hemorrhagic stroke during the first year post stroke. Methods 117 persons with stroke (ischemic n=98, hemorrhagic n=19) and reduced upper extremity function 3 days after onset were consecutively included to the Stroke Arm Longitudinal Study at the University of Gothenburg (SALGOT) from a stroke unit. Upper extremity motor function and activity capacity were assessed at 6 time points during the first year; age and initial stroke severity were recorded. Possible differences between groups in extent of change over time of upper extremity motor function and activity capacity were analyzed with the Mixed models repeated measurements. Results Significant improvements were present in function and activity in both groups within the first month (p= 0.001). Higher age and more severe stroke had a negative impact on recovery in both groups. Larger improvements of function and activity were seen in persons with hemorrhagic stroke, both from 3 days to 3 - and 12 months, and from 1 month to 3 months. Both groups reached similar level of function and activity at 3 months post stroke. Conclusions Poor initial motor function or activity capacity could mislead expertise and exclude persons with hemorrhagic stroke from further intensive rehabilitation.
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40.
  • Persson, Hanna C, 1979, et al. (författare)
  • Life situation 5years after subarachnoid haemorrhage
  • 2018
  • Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314. ; 137:1, s. 99-104
  • Tidskriftsartikel (refereegranskat)abstract
    • ObjectivesSubarachnoid haemorrhage (SAH) has high mortality and morbidity among survivors. SAH mainly affects young people and may result in long-term disabilities such as decreased Health-related Quality of Life (HRQoL), mental health and cognitive function. The aim of this study was to investigate the life situation 5years after a SAH including physical/emotional status, participation and HRQoL. Materials & MethodsIn this cross-sectional descriptive study, a mail survey was sent to all persons treated at a neurosurgery unit in Gothenburg, Sweden, for non-traumatic SAH in 2009-2010, approximately 5years post-SAH. The survey included questions regarding HRQoL; EuroQol 5-Dimensions (EQ-5D), the impact of the SAH; Stroke Impact Scale (SIS), Occupational Gaps Questionnaire and participation in society; Impact of Participation and Autonomy (IPA). ResultsForty-two 5year survivors were sent the survey, of whom 26 (62%) responded (59years old, range 33-85). The participants had generally low HRQoL and scored low in the domain of anxiety and depression. Many reported problems with emotions, fatigue, memory and executive function, but few problems with physical condition. However, nearly all participants reported to have an acceptable level of participation and 64% were independent in their daily life. ConclusionsIn this 5-year follow-up after SAH, the participants reported to have a greater number of hidden disabilities compared to physical problems, whereas most had acceptable participation in society. A yearly follow-up after a SAH could be suggested aiming to improving the cognitive and mental health.
  •  
41.
  • Persson, Hanna C, 1979, et al. (författare)
  • Motor function in ischemic and hemorrhagic stroke during the first year
  • 2015
  • Ingår i: the World Confederation for Physical Therapy Congress 2015.
  • Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
    • Background: Few studies have investigated motor function in the upper extremity in both ischemic or hemorrhagic stroke. Different recovery patterns in upper extremity motor function have clinically been described, but there is a lack of research. Purpose: To investigate differences in recovery of upper extremity motor function after ischemic or hemorrhagic stroke during the first year after a stroke. Methods: From the Stroke Arm Longitudinal Study at the Gothenburg University study, 45 people fulfilled eight assessment occasions during twelve months after a first ever stroke. People who had first ever stroke and reduced upper extremity function at day three post stroke were included in the study. Upper extremity motor function was investigated with the Fugl-Meyer Assessment for Upper Extremity (FMA-UE) at day 3, day 10, at 3, 4 and 6 weeks and at 3, 6 and 12 months. Descriptive statistics was used to present data, to compare differences between ischemic or hemorrhagic stroke, subgroup analyses were performed at every occasion using the Mann-Whitney U-tests. Results: Of 45 people, 33 had ischemic stroke, and twelve had hemorrhagic stroke. There was a crossover in mean level of upper extremity motor function, with lower level of function in people with hemorrhagic stroke compared to ischemic stroke from day three to one month. In one month to one year, the mean level of upper extremity function was higher for people with hemorrhagic stroke. No statistically significant differences in upper extremity motor function between the two groups were seen at any of the eight assessments during the first year after stroke. Conclusion(s): No significant differences were seen in upper extremity motor function between hemorrhage and ischemic stroke. On average those with hemorrhagic stroke seemed to have lower level of upper extremity motor function from day three to one month post stroke, but thereafter have a higher level compared to ischemic stroke. Implications: Based on this study, the implication could be that the rehabilitation of upper extremity motor function during the first year after a stroke, should not be changed due to if the patient have ischemic or hemorrhagic stroke, but should be individual based.
  •  
42.
  • Persson, Hanna C, 1979, et al. (författare)
  • Motor function recovery in patients with ischemic versus hemorrhagic stroke during the first year
  • 2015
  • Ingår i: Nordic Stroke 2015. 18th Nordic Congress on Cerebrovascular Diseases. 26-28 August 2015, Malmö, Sweden.
  • Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
    • Background and purpose Few studies have investigated the recovery of motor function in the upper extremity according to the sub types ischemic and hemorrhagic stroke. Different recovery patterns in upper extremity motor function have clinically been described, but there is a lack of research. The purpose of the present study was to investigate possible differences in the recovery of upper extremity motor function in patients with ischemic versus intracerebral hemorrhagic stroke during the first year after a stroke. Materials and methods Patients with a first ever stroke and impaired upper extremity function 3 days after onset were consecutively included in the Stroke Arm Longitudinal Study at the Gothenburg University study during 2009-2011. Upper extremity function was investigated with the Fugl-Meyer Assessment for Upper Extremity (FMA-UE) at 3 and 10 days and at 1, 3, 6 and 12 months, age and initial stroke severity were assessed day 1. To compare changes over time in ischemic and hemorrhagic stroke, the Mixed model repeated measurement was used. A p-value <0.05 at was considered statistically significant. Results Of 117 patients, 98 had ischemic (mean 70 years), and 19 had hemorrhagic stroke (mean 62 years). A wide spread in upper extremity motor function recovery was seen. Statistically significant differences over the first year between ischemic and hemorrhagic stroke (interaction of type of stroke and time since onset, p= 0.001 at 3, 10 days and 1 month) were seen, where patients with ischemic stroke started at a higher FMA-UE level but at 3 months the two groups had approximately same level of motor function. Initial stroke severity and age had a significant impact on the recovery pattern. Conclusion Patients with ischemic stroke has during the first 3 months higher motor function and recover faster compared to hemorrhagic stroke. Thereafter no significant difference was seen. The type of stroke (ischemic or hemorrhagic) is of most relevance for the recovery process in the sub-acute phase, but still, the wide-ranging individual changes emphasizes the importance of individually based rehabilitation. Further studied are needed to confirm these results.
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43.
  • Persson, Hanna C, et al. (författare)
  • Neurologiska hälsotillstånd : Inverkan på trafikskadehändelser och säkerhet
  • 2023
  • Rapport (övrigt vetenskapligt/konstnärligt)abstract
    • Detta projekt hade som syfte att undersöka samband mellan olika hälsotillstånd och skadehändelser i trafiken, med fokus på neurologiska sjukdomar. Projektet utgår från två uppsatser vid Göteborgs samt en vetenskaplig artikel. Projektet har utgått från registerdata från Transportstyrelens olycksregistrering i databasen Strada (Swedish Traffic Accident Data Acquisition) kring personer som varit involverade i en trafikolycka i Sverige under åren 2010–2019. Om dessa personer också har en neurologisk sjukdom så som Parkinsons sjukdom, Multipel Skleros (MS), stroke eller epilepsi undersöktes via Socialstyrelsens diagnosregister. En jämförelsegrupp med personer med tarmrelaterade diagnoser användes (som inte hade en väntat högre risk för olycka). I projektet undersöktes också typ av olycka, tid från diagnos till olycka och sjukdomsgrupper jämfördes.Sammanfattningsvis visar projektet att personer med epilepsi och personer med Parkinsons sjukdom skiljer sig avseende typ av trafikolycka, men även kring skadans svårighetsgrad jämfört med annan neurologisk sjukdom samt med en jämförelsegrupp. Personer med Parkinson sjukdom och de med epilepsi var i större utsträckning involverade i singelolyckor, blev mer alvarligt skadade och olyckan skedde också i tid närmare från när de erhöll sin neurologiska diagnos. Det finns många potentiellt bidragande faktorer som kan orsaka en olycka, men oavsett påvisar projektet att dessa sjukdomsgrupper kan behöva följas upp avseende körförmåga, både tidigare efter diagnos och under längre tid, för att minimera risker i trafiken. Baserat på resultaten verkar det inte som individerna som har haft stroke eller de som har MS är mer involverade trafikolyckor på gruppnivå. Funktionsnedsättningarna och dess svårighetsgrad varierar dock stort, vilket kräver en noggrann individuell uppföljning och bedömning när ett köruppehåll ska upphöra eller kan fortsätta.
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44.
  • Persson, Hanna C, 1979, et al. (författare)
  • Outcome and upper extremity function within 72 hours after first occasion of stroke in an unselected population at a stroke unit. A part of the SALGOT study.
  • 2012
  • Ingår i: BMC neurology. - : Springer Science and Business Media LLC. - 1471-2377. ; 12:1
  • Tidskriftsartikel (refereegranskat)abstract
    • ABSTRACT: BACKGROUND: Reduced upper extremity function is one of the most common impairments after stroke and has previously been reported in approximately 70-80% of patients in the acute stage. Acute care for stroke has changes over the last years, with more people being admitted to a stroke unit as well as use of thrombolysis. The aim of the present study was to describe baseline characteristics, care pathway and discharge status in an unselected group of patients with first occasion of stroke who were at a stroke unit within 72 hours after stroke and also to investigate the frequency of impaired arm and hand function. A second aim was to explore factors associated with impaired upper extremity function and the impact of impairment on the patient's outcome. METHODS: Patients over 18 years of age with first ever stroke, living in a geographical catchment area, being at the stroke unit within 72 hours after onset, with no prior upper extremity impairment were included. Baseline characteristics, arm and hand function within 72 hours, stroke outcome and care pathway in the acute phase were described, by gathering information retrospectively from the patients' charts. Ischemic strokes were categorized according to the Bamford classification and the Trial of Org 10172 in Acute Stroke Treatment criteria. RESULTS: Of the 969 patients with first ever stroke who were screened, 642 patients fulfilled the inclusion criteria. According to the National Institutes of Health Stroke Scale (NIHSS), the patients had a mean score of 5.6, median 3.0, at arrival to the hospital. Ischemic stroke was most frequent in the anterior circulation (87.7%). Within 72 hours after stroke onset 48.0% of the patients had impaired arm and hand function and this was positively associated with higher age (p < 0.004), longer stay in the acute care (p < 0.001) and mortality in acute care (p < 0.001). Directly admitted to the stroke unit were 89.1% of the patients and 77.1% received hospital care on same day as stroke onset. Mean length of stay in the stroke unit was 9.9 days, 56.8% of the patients were discharged directly home from the stroke unit. Mortality within 72 hours after stroke onset was 5.0%. CONCLUSION: Impaired arm and hand function is present in 48% of the patients in a non selected population with first ever stroke, estimated within 72 hours after onset. This is less than previously reported. Impaired arm and hand function early after stroke is associated with higher age, longer stay in the acute care, and higher mortality within the acute hospital care.
  •  
45.
  • Persson, Hanna C, 1979, et al. (författare)
  • Patientens skattade arm och handstyrka i korrelation till objektiva mätningar 10 dagar efter en förstagångsstroke; en del av SALGOT-studien.
  • 2013
  • Ingår i: Sjukgymnastdagarna 2013. Göteborg 2-4 oktober 2013.
  • Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
    • Bakgrund och syfte Kunskap om patientens förståelse av funktionsnedsättning efter stroke är bristfällig. Få studier finns, varav ingen som omfattar akut skede. Syftet med studien var att undersöka patientens upplevad arm och handstyrka 10 dagar efter insjunkande i stroke och hur denna korrelerar till objektiva mätningar. Metoder Etthundra patienter med förstagångsstroke och nedsatt arm och handfunktion 3 dagar efter insjuknade, boende i Göteborgsområdet, undersöktes från studien Stroke Arm Longitudinal Study at the University of Gothenburg (SALGOT). 10 dagar efter insjuknade, skattade patienten sin funktion i övre extremitet på två delmoment av Stroke Impact Scale; styrka i arm respektive i hand i afficierad sida. Övre extremitet bedömdes med greppstryka mätt med JAMAR samt med aktivitetsskalan Action Research Arm Test (ARAT). Korrelationsberäkningar genomfördes. Resultat Hög korrelation visades mellan patientrapporterade styrka i hand och i greppstryka mätt med JAMAR; roh 0.86 and i arm; rho 0.81. Hög korrelation fanns även mellan patientrapporterade styrka i hand och med ARAT; rho 0.83 och i armen; rho 0.79. Samtliga korrelationer med signifikansnivå på p<0.05. Konklusion Denna studie visar att 80% av de patienterna deltog, redan 10 dagar efter stroke klarar att korrekt skatta styrkan i påverkad arm och hand. Detta indikerar på att det finns god överensstämmelse mellan patientens skattade styrka och objektiva mätningar redan tidigt efter stroke.
  •  
46.
  • Persson, Hanna C, 1979, et al. (författare)
  • PREDICTION OF ARM FUNCTION WITHIN ONE YEAR AFTER STROKE USING A SHORT ASSESSMENT
  • 2014
  • Ingår i: The 8th World Congress for NeuroRehabilitation. ; Ref no 319:PP-156
  • Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
    • Background: A clinical test is needed, with the possibility through an early assessment to correctly predict clinical relevant arm function in patients with stroke, which would be appropriate for the patient, staff and when planning for future care and rehabilitation. Aims: There are two purposes of the present study. First; investigate if items from the Action Research Arm Test (ARAT) can be extracted to create a diagnostic test easy to perform in the clinic during the acute stage of stroke with the possibility to predict upper limb function and activity, second; assess the new test’s possibility to predict sufficient motor function ability to drink from a glass with the impaired arm. Methods: In the study 112 patients were assessed at day 3, day 10, week 4 and month 12 after stroke onset. Clinically feasible items from the ARAT able to detect sufficient motor function ability to drink from a glass with the impaired arm during the first year after stroke were selected in a structure process. An appropriate cut-off for the diagnostic test was chosen with Receiver Operation Characteristic (ROC) curves. In the second step the chosen items’ possibility to predict upper extremity function and activity were tested with 2-way contingency table. Results: Two items from ARAT; “Pour water from glass to glass” and “Place hand on top of head” were structured selected to a diagnostic test with a total sum of 0-6 p. A cut-off level of 0-1/2-6 p was identified, having an Area Under the Curve (AUC) of 0.91-0.99 presented in the ROC-curves. The percent of correctly predicted patients over all were between 80.8% and 96.4% in the different test occasions. The diagnostic test had the ability to correctly predict motor function of patients having some dexterity at day 3, Negative Predictive Value (NPV) day 10, 0.98, week 4 and month 12 1.0. The Positive Predictive Value (PPV) was high day 10, 0.95, but lower thereafter; week 4, 0.77, month 12, 0.61. From assessments week 4, the PPV/NPV in month 12 were 0.79/1.0. Conclusions: It is possible to, from a short assessment (two items from ARAT) at day 3 post stroke predict sufficient motor function ability to drink from a glass with the paretic arm during the first year. The percentage of correct over all prediction varies between 81 -94%. Keywords: prognosis, stroke, upper extremity
  •  
47.
  • Persson, Hanna C, 1979, et al. (författare)
  • Symptoms and consequences of subarachnoid haemorrhage after 7years.
  • 2019
  • Ingår i: Acta neurologica Scandinavica. - : Hindawi Limited. - 1600-0404 .- 0001-6314. ; 140:6, s. 429-434
  • Tidskriftsartikel (refereegranskat)abstract
    • Short-term follow-up studies after a subarachnoid haemorrhage (SAH) have shown impaired cognition, fatigue, depression and anxiety, but less is known regarding long-term consequences. The aim of this study was to investigate health outcomes in persons 7years after SAH.This is a descriptive cohort follow-up study of persons with non-traumatic SAH treated at Sahlgrenska University Hospital, Gothenburg, Sweden. The follow-up was conducted 7years post-treatment and included home visits using forms and questionnaires about health outcomes; the Barthel Index (BI), modified Rankin Scale (mRS), National Institutes of Health Stroke Scale (NIHSS), Hospital Anxiety and Depression Scale (HADS), Montreal Cognitive Assessment (MoCA) and Multidimensional Fatigue Inventory (MFI).Seven years post-SAH, 33 persons fulfilled the inclusion criteria, of whom 18 (55%) participated (median age 63years). Cognitive impairment was present in 11 participants, assessed with the MoCA, where the item of delayed recall was most difficult. The majority (n=16) were independent in activities of daily living (ADL), and few (n=3) had physical symptoms according to the NIHSS. However, three participants were free from disability according to the mRS. Nearly, half of the participants had symptoms of anxiety (n=8). Three had symptoms of depression and more than half experienced fatigue.The physical function and independency in ADL is high among long-term SAH survivors. Despite this, only a few were completely free from disability, and the main problems 7years after SAH were cognitive impairment and anxiety.
  •  
48.
  • Persson, Hanna C, 1979, et al. (författare)
  • Transport mobility 5years after stroke in an urban setting.
  • 2018
  • Ingår i: Topics in stroke rehabilitation. - : Informa UK Limited. - 1945-5119 .- 1074-9357. ; 25:3, s. 180-185
  • Tidskriftsartikel (refereegranskat)abstract
    • Background People after stroke may have residual problems with mobility that can affect their independence and mode of transport. However, there is limited knowledge about transport mobility several years after stroke. Objective The objective was to survey the outdoor mobility and transportation in an urban setting five years post-stroke. Method This cross-sectional study was based on a mail survey focusing on long-term consequences after stroke. The survey comprises a set of self-evaluated questionnaires and was sent to 457 persons, of whom 281 responded (61.5%). From the survey, items regarding transportation and mobility were selected and analyzed. Results A high level of mobility function was reported with regard to outdoor mobility and different modes of transport. However, one-fifth still reported problems with outdoor mobility and mode of transport. Some perceived barriers were reported, predominantly mobility aspects such as transfer to/from, and getting on/off specific transportation mode/s. The respondents reported some communication problems and cognitive impairments, but these were not reported as prominent barriers when using public transport. A total of 67% were active drivers and were more often men (p=0.002), younger (p≤0.001), and were less dependent at discharge from the acute hospital (p≤0.001). Conclusions Five years post-stroke, mobility problems were the dominant barrier reported when using transport modes. Individualized transport training is needed during rehabilitation to increase possibility to participate. Infrastructure and transportation planning should focus on older, women, and people with impairments to be able to facilitate the use of public transport and mobility.
  •  
49.
  • Persson, Hanna C, 1979 (författare)
  • Upper extremity functioning during the first year after stroke
  • 2015
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • The overall aim of this thesis was to investigate upper extremity functioning during the first year after stroke from different perspectives. Methods. All patients with first ever stroke, admitted to a stroke unit within 72 hours after stroke incidence were included during a period of 18 months. The prevalence of impaired upper extremity function was investigated within 72 hours. Differences in change over time in functioning (function and activity) between patients with ischemic and hemorrhagic stroke were explored. The possibility of a simple early assessment to predict the level of upper extremity motor function required for a drinking task was investigated, as well as the relationship between patient-perceived and assessed strength capacity. The studies are a part of the SALGOT-study (The Stroke Arm Longitudinal Study at the University of Gothenburg). Main results. Of patients admitted to a stroke unit, 48% had impaired upper extremity function within 72 hours after stroke onset. In patients with impaired upper extremity function initially, those with hemorrhagic stroke had a larger improvement from 1 to 3 months in their function and activity compared to patients with ischemic stroke. Patients with hemorrhagic and ischemic stroke improved function and activity to a similar level 3 months and thereafter. Two items from the Action Research Arm Test (ARAT) used at 3 days post stroke could accurately predict the level of motor function required for a drinking task at three later time points during the first year post stroke. Assessed grip strength capacity and perceived strength at 10 days post stroke correlated highly, but some patients rated their strength differently compared to the assessment of strength capacity. Conclusions and clinical implications. Fewer patients than previously described had impaired upper extremity function early after stroke which is of importance in planning of care and rehabilitation. In patients with impaired upper extremity function, larger improvements of function and activity were seen after 1 month in those patients with hemorrhagic stroke compared to ischemic, but both stroke types reached a similar level at 3 months post stroke. These results together with the finding that early prediction of function is possible, and that a combination of patient-reported and objective strength assessment early after stroke may be valuable in planning of care, rehabilitation and goal setting, and therefore improve the overall rehabilitation process.
  •  
50.
  • Persson, Hanna C, 1979, et al. (författare)
  • Upper extremity recovery after ischaemic and haemorrhagic stroke: Part of the SALGOT study
  • 2016
  • Ingår i: European Stroke Journal. - : SAGE Publications. - 2396-9873 .- 2396-9881. ; 1:4, s. 310-19
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction The purpose was to explore if there are differences in extent of change in upper extremity motor function and activity capacity, in persons with ischaemic versus haemorrhagic stroke, during the first year post stroke. Patients and methods One hundred seventeen persons with stroke (ischaemic n=98, haemorrhagic n=19) and reduced upper extremity function 3 days after onset were consecutively included to the Stroke Arm Longitudinal Study at the University of Gothenburg (SALGOT) from a stroke unit. Upper extremity motor function (Fugl-Meyer Assessment Scale for Upper Extremity (FMA-UE)) and activity capacity (Action Research Arm Test (ARAT)) were assessed at 6 assessments during the first year; age and initial stroke severity were recorded. Differences between groups in extent of change over time of upper extremity motor function and activity capacity were analysed with mixed models repeated measurements method. Results Significant improvements were found in function and activity in both groups within the first month (p=0.001). Higher age and more severe stroke had a negative impact on recovery in both groups. Larger improvements of function and activity were seen in haemorrhagic stroke compared to ischaemic, both from 3 days to 3- and 12 months, and from 1 month to 3 months. Both groups reached similar levels of function and activity at 3 months post stroke. Conclusion Although persons with haemorrhagic stroke had initially lower scores than those with ischaemic stroke, they had a larger improvement within the first 3 months, and thereafter both groups had similar function and activity.
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